MIDWIFING A LOVED ONE Some Persona1 Reflections

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At one time or a”otber, probably every nurse-midwtle has provided care to e friend. relative, or CQI- league. Perhaps it was a diaphragm fitting or a” annual yynecologrcal exam. It may have t.:on the u?&~ate t” mtdwifing: the tender. loving care delivered during pregnancy and biti. Regardless of the nature of iie care, one thing is vey certain: Sew eraI concerns shouid be reckoned with before a nurse.midwife agrees to become the pdmay aregtver for a familv member end/or friend. Perhaps-it ts time to reflect on some of the oatential problems ass0eiete.l with prc&ng s&h a” intimate and demanding service for those with whom we are closest

As an experienced clinician who her provided matcnlty, interconcep- tual. and welt-woman care to several fdends, relatives. and colleagues, I address this professional problem from a personal perspective. I have sew? 3 !l-&ice to n +qse and aQ a family plan”ing counselor to no- merow relattves, and I delivered my daughter’s first baby last annmer. Moreover. it has bee” a two-way ex- pede”ce: I have also been the recip- rent of gy”ec0lqdw.l care. as well as cafe throughout the maternity cycle, from colleagues of mine.

In truth the most ddftcult exp,-1. exe for me was that of watching my own daughter’s pain as she pro- gressed through her first labor !.a sumlner. It was huly a self-taught lesson I” humility Because I wanted to keep vagina! exams to a mtnlmum

fSRCf4 odor to labor). I iudaed her labor pr&ess solely t$ i ;ten@b of her contractions. Although she coped well with her labor and never asked for any medicetim for her dis- comfort, all of my midwife sz!ws to’3 me “at least 7 cmP’ as we drove to !he hospital (Ii hours after i”i6al exam of 2 cml. To my disrrzy, he.+ e !er, ehe was only 4 to 5 cm dilated

.I L,. .._ .._.,..I l’lrl” our e?!?i’iil r> “,ti ,‘““~,Ln,, dC- roxiing to her “official’ nurse-mid- wife. 1 soon realized that my ma- tsrnal emotional resoonses to her rtin were deftnitely &ore powerful fx me than the clinical exoertise that generally guided my professional judgments.

We need to examine OUT motives ior offering OUT speciabzed personal are to those tith whom we are 50 close. Is It done to ensure that they get the best care possible? Is it done to show off expertise and to gain respect for professional skills that there would otbetise be no oppar- hlnitv to demons&ate? Is it done to sh& in a untque eupe&isi m the lives of our friends, relatives. or cot. leagues? Is it done to protect them from e system in which they may not get truly personalized care? Do we unintentfonally place others in 2 pa- sltlon of indebtedness’ Do we con- sider it evldccce of professional “popUk¶d~?

In each Individual tnstance, we need to think through all 01 the reasan~ we find far wanting to pro- dde midwifery care to the special people in our lives. Some of the

reesons wtll be admittedly selfish. some of them altruistic. Envision the rewards: Whose p&se do you imagine hearing? Whet is it that you picture happ&ing if you are not thzre’ What reaons are roost kn- pxtant and to whom arc they im- patwt? As :uwmidwtves we all have way &ailed id& f& labor and delivery, but these id& are ow own and will certainly not be uni- ~vez! !(, ewrvme we cam for. even

While examMIng our motives for Involvement, we must recogntze that one of the essentials of “good” nurse-midwifery care is objectivity. We need to be one step removed from enwttonal involoement with the laboring woman o< ive may lose SollIe perspective about the progress of labor, appropriate management of pain, and need for intervention. By virtue of the personal involvemen the profeMnlars ability to manage labor safely and objectiuely can be compromised. The numbing implt- cation of this 1s the walhatton that we may Inadvertently be the cause of mlsmarragement, overmedication, unnecewy tntervenhon, or delayed ation-because we care so much.

Entiston a mistake o: M aode. sired outcome. What if your best fdend hemorrhages portpartally? What 1f your daughter (or sister ot niece) has a severe lacemUon? What if .? How will you feel? And just as

imwxtantlv. how will she and her

far& fee!! Wow yet, while you’re thinking about it, imwine that the less-thz-pedect outcome muld be y~mr fault, in part or m ftil.

When one nurse-midwife seeks midwifery care from a colleague. there is the touchy issue of whom to choose in a setting with several nurse-midwives. Nurse-midwives tend to be people who an “en/ eet- sitive to personal issues. Might one agonize over hurt feelings when choosing one colleague over an- other? Such perwrnal considerations con dictate site of birth and elaborate

systems of care designed to IncLJe people who may have been more petipherally involved, had the only consideration been socd care.

Then, too, nurse:midwiues are a demandins bunch. Who’d want them 25 patients? Well, lots of people do, because it ia a mark of high es- teem to be chow to provide care tn a nurse-midwife. So, in spite of the drawbacks that are numerous and fairly obvious, few of us will ever say “No” when another nurse-midwife bestmus upon us the honor of asking us to be her midwife.

In tying to be too many things to too many people. we can set our- selws up for sane major disappoint-

ments. When a close colleague whom I had attended during labor needed a cesarean section, I awn- lied about it for two years after&d. Could the problem have been are- cipiteted :i the pain relief I oldered for her? When she asked me to be

her nursemidti!e again for her next

pregnancy, I conwioudy set out to avoid the emotional temptation of premah~rely alleviating her pain. In doing so, I avoided my fdend all day while she labored at home. If I had not been so intent on being her mid- wife, might I have been mo:e ui a fdend by being there to support her through early labor? Thus, in my ful- Rllment of one role, did I sacrifice an- other? Which was more valuable?

While attempting to find my role as midwife-mother to my daughter.

I found that I could barely sleep at night while wailing for her to go into labor ar the days crept to two weeks past her EDD. I had envisioned a calm and positive role for myself. with an appreciative son-in-law, an envious co-mother-in-law. grateful and admiring family ali around, and a uniquely forged bond with my daughter to supersede all other mother-daughter bands in the uni- verse.

She had received the benefit of good prenatal care from a nurse- midwife in a nearby con....@, and I frequenfly checked the fetal heart and fundal growth and answered many of me ilsu?.l questions as well. Fortunately, the nurse-midwife was euoootive end willino to be tlexible about my desire to beinvolved in the birth while 1 admitted that I did not know how much I would be capable of doing.

My datighter’s perfectly normal labor did not fulfill the fantasies I had envisioned. My own expectations for the rewards that were in it for me were vastly overrated. My son-in-law took quite some time to get over feeling that his wife had a nineteenth centu-y birth in the hueatieth cen- tury. His parents thought it was to- tally improper that a wxnan in labor

should remain at home for so long, My entire famiiy felt that 1 was totally preoccupied with one person to the detdment of everyone else for far too long. And my daughter turned to her husband for support during labor and for comfort after de&y, corn- pletely ignoring me. Don’t forget the blow to my self-esteem for not even being able to assess progress of labor to the extent that I could not eyeball the difference behveen 4 and I cm in someone I had been watching for 12 hours. It may have been a normal labor for her, but not for me. I had received more appreciation for fr: less from total strangers.

Upon examination of my motives, I found that most of the reasons for my involvement in my daughter’s birth were my own. Yes, she invited

me to “do the deliverw” but she didn’t know what that &anf end I did. Or oerhaas. it meant different things to each bf us. I think she would have had just as nice a labor and delivey (with the exception of being labor sat at home by a doting mother) without my attempts to b. so actively involved in management.

The absolute joy that cornea horn being a nurse-midwife is something about which we probably don’t need remindas. That’s why we came to it in the first place. Is the iou anv greater when the dell&; of a child is your best friend’s or your daughter’s? For me it was; but, there were definite drawbacks as well. Still. hope and the reallzaiion of that hop; will probably keep nurse-midwives in the position of hying to s&addle two paths that often do no: follow the same direction.

As with .so many other complex- ities in life, the best answer lies not with where we find buth but in which hutb weighs more et any particular point In time. We can try to midwife each other and our friends and daughters, but we should carefully examine, in each case, motivations, options, and pitfalls. For whom are we doing it? Why are we doing it? And given the who and the whv. how can we ensure that everyan& needs and goals will most likely be met?

It is comforting to note that in many of the birth announcements that ewear in Qulckenfns, there is more than one nurse-ml&fe in at- tendance and often a physician as well Rscause one of the greatest po- tential shortcomings in having a fdend (or mother) in a management role at bii is lack of objectivity, two (or three) heads wfil be better than one.

Each set of circumstances. each borrd of fdendehip will have its own unique circumstances. We will all, necessarily, need to make these de- cisions on an individual basis. How- ever, we need to be more cognizant of the hazards :o our own ~ndividuai

Joumd of Nurse-Midwifery l Vnl. 35. No. 5. SeptemkrrlOctober 1999

psyche when we place these addi- and they will get more ou of :he LX- our Mends and daughtqrs the berr tional burdens on ourseIves. and we perience whe” ir‘ admit that we

need to be “-ore aware of the efit. warmth, and safety that some-

can’t fulfill both the pw.onal and one else can provide when we burdens we place on our friends professional roles completely and si- can’t do it all.

when we ask them t” be “IX mid- mu!taneously. Then, we (a” pick ‘he Carol wooi. c?“iN, !&St4

wives. In Some circumstances, we piece we want the mo~l and allow Contributing Editor

UPCOMING HOME-STUDY PROGRAMS

Ths November/December 1990 issue of J,“IM wii! feature a

home-study program on “Well-Woman Gyn~o!ogy.” Patici-

panrs uill be eligible for ACNE-approved CEUs that u.4 patiy

satisfy the requirements for Continuing Competency Assessment

“The Newborn” is the designated theme for JNMs third an-

nual home-study prwam, which is !argeted for the January/Feb-

wary 1992 issue ofJNM. Ar.j~“e interested in etibmiting zu1 ab-

stract for consideration should iir ‘c bjr March 1, :9X. Final

menuscripts uill be due into ACNM headquarters by July 1,

1991, and should comply with JNM’s guidelines for publication.

Journal of Nurse-Midwifery . Vol. 35. No. 5, Sept?mbcrlOctober 1990 265